Adherence barriers to inhaled medicines in Japanese older patients with asthma evaluated using the “Adherence Starts with Knowledge 20” (ASK-20) questionnaire

Abstract

Objective: We investigated adherence barriers to inhaled medicines among older compared to younger adults with asthma in Japan. Methods: Adherence barriers to inhaled medicines were evaluated in 251 Japanese older (n = 138) and younger (n = 113) adults with asthma using the self-reporting “Adherence Starts with Knowledge 20” (ASK-20) questionnaire. Results: There were fewer older adults with poor adherence to inhaled medicines than younger adults. The ASK-20 questionnaire revealed (odds ratio [95% confidence interval]) item Q11 (“My doctor/nurse and I work together to make decisions”; 2.94 [1.31, 6.61]; p < 0.05) as an independent adherence barrier to inhaled medicines among older adults, whereas younger adults reported item Q3 (“My use of alcohol gets in the way of taking my medicines”; 3.91 [1.02 to 15.1]; p < 0.05) and item Q16 (“Taken a medicine more or less often than prescribed? “; 2.31 [1.32 to 4.06]; p < 0.05) as barriers. Older adults with poor adherence identified item Q1 (“I just forget to take my inhaled medicines some of the time”; 4.43 [1.77, 11.1]; p < 0.05) as a barrier, although the total ASK-20 scores and total barrier counts were significantly higher in older (both, p < 0.05) and younger (both, p < 0.05) adults with poor adherence than in those with good adherence. Conclusion: Older Japanese patients had better adherence to inhaled medicines than younger patients. Barriers were different between older and younger adults. These results will help personalize education for inhaled medicines in Japanese asthmatics.

Keywords:

• Biomarkers
• control/management
• education
• quality of life

Acknowledgements

The authors thank all the study collaborators of the Kyushu Asthma Seminar Investigator Group: Prof. Hirotsugu Kohrogi, Kumamoto University; Dr. Tomoaki Iwanaga, National Hospital Organization Fukuoka Hospital as representative organizers, and Prof. Yoichi Nakanishi, Kyushu University; Prof. Hiroshi Mukae, Nagasaki University Graduate School of Biomedical Sciences; Prof. Kentaro Watanabe, Fukuoka University; Prof. Shinichiro Hayashi, Kohokai Takagi Hospital; Prof. Junichi Kadota, Oita University Faculty of Medicine; Prof. Hiromasa Inoue, Kagoshima University; Prof. Jiro Fujita, University of the Ryukyus; Dr. Takao Tochigi, Kamoike Seikyo Clinic; Dr. Hiroshi Nakamura, Nakamura Clinic; Dr. Toshihiko Ii, National Hospital Organization Miyazaki Higashi Hospital as members who assisted with the general organization of the study.

Physicians and members of institutes contributing to the enrollment of patients and collection of data are as follows: Dr. Chizuru Torigoe, Dr. Suehiro Nishio, Dr. Takuya Ueno, and Dr. Toshiyuki Sawabe at Beppu Medical Center; Dr. Motokimi Shiroishi at Fukuoka University Hospital; Dr. Keiko Mizuno, Dr. Ikkou Higashimoto, Dr. Masaki Watanabe, Dr. Masuki Yamamoto, and Dr. Takuya Samukawa at Kagoshima University Hospital; Dr. Ken Yoshinaga and Dr. Naomi Hirata at Kumamoto Chuo Hospital; Dr. Koichiro Fukuda at Kumamoto City Hospital; Dr. Kazuyoshi Nakamura and Dr. Yuki Tenjin at Kumamoto Saishunso National Hospital; Dr. Masao Nakao, Dr. Msashi Suetomo, Dr. Ryusuke Tomioka, Dr. Keisuke Zaizen, Dr. Mamoru Nishiyama, Dr. Yoshiko Sueyasu, and Dr. Yusuke Okayama at Kurume University Hospital; Dr. Akiko Ishimatsu, Dr. Makoto Yoshida, Dr. Masashi Komori, Dr. Michiyoshi Imaoka, Dr. Reiko Kishikawa, and Dr. Yoshihiro Isaka at National Hospital Organization Fukuoka Hospital; Dr. Arisa Sano, Dr. Shigehisa Yanagi, Dr. Toshiniko Ii, and Dr. Yumi Iwa at National Hospital Organization Miyazaki Higashi Hospital; Dr. Hiroyuki Matsumoto and Dr. Tetsuya Otani at Oita Prefectural Hospital; Dr. Hiroki Yoshikawa, Dr. Hisako Kushima, Dr. Issei Tokimatsu, Dr. Kenji Umeki, Dr. Satoshi Toba, Dr. Yutaka Mukai, Dr. Atsuko Iwata, Dr. Hiroko Tamuko, and Dr. Kenshi Kishi at Oita University Hospital; Dr. Minoru Ohama at Tenshindo Hetsugi Hospital; and Dr. Chinatsu Nishida, Dr. Kazuhiro Yatera, Dr. Kei Yamasaki, Dr. Minako Hanaka, and Dr. Yukiko Kawanami at University of Occupational and Environmental Health, Japan.

Disclosure statement

The conflicts of interests in each author were described as below, although there were no conflicts of interests in the trial. However, the operating and travel expenses for the annual meeting of the Kyushu Asthma Seminar were supported by Teijin Pharma Ltd (Tokyo, Japan). Dr. Jun Sasaki did not have any conflicts of interests.

Additional information

Funding

Dr. Tomotaka Kawayama received grants from AstraZeneca Japan, Merck (MSD KK) Japan and Novartis Pharmaceuticals Japan, and lecture fees from Novartis Pharmaceuticals Japan, GlaxoSmithKline KK (GSK) Japan, Boehringer Ingelheim Japan, Kyorin Pharmaceutical Co. Ltd, Astellas Pharma, and AstraZeneca Japan. Dr. Makoto Yoshida received lecture fees from Boehringer Ingelheim Japan and GSK Japan. Dr. Koichiro Takahashi received grants from Novartis Pharmaceuticals Japan, and AstraZeneca Japan and MSD KK, and lecture fees from Novartis Pharmaceuticals Japan, Boehringer Ingelheim Japan, Kyorin Pharmaceutical Co. Ltd, AstraZeneca Japan, Teijin Ltd, and Meiji Seika Pharma. Dr. Kazuhiko Fujii received lecture fees from Boehringer Ingelheim Japan, GSK Japan, Astellas Pharma, Teijin Ltd, and AstraZeneca Japan. Dr. Kentaro Machida did not have any conflicts of interests. Dr. Takashi Kinoshita received grants from GSK Japan and AstraZeneca Japan, and a lecture fee from AstraZeneca Japan. Prof. Tomoaki Hoshino received a grant from GSK Japan, Novartis Pharmaceuticals Japan and Chugai Pharmaceutical Co. Ltd.